Ketamine for Depression: 10 Essential “Infusion-Confusion” Busters

Bill WhiteFebruary 8, 2016

There was a time when ketamine would have been mentioned here only within the context of substance misuse. However, the times, they have changed. And now it’s about ketamine for the treatment of depression. Lots going-on and lots to be misunderstood. So let’s do some “infusion-confusion” busting…

Ketamine is available right now. Sure, why not? It isn’t illegal, just needs to be administered by a physician. And by far the most common administration method is intravenous infusion.

Ketamine is used in human and veterinary medicine. In humans, it’s utilized as an anesthetic, as well as for the relief of pain, bronchospasm, and then some.

And, yes, it’s used recreationally (“Special K”) at sub-anesthetic hits. The point? Experiencing a mighty dissociative state, and with any luck at all, hallucinations. It’s called hitting the “K-Hole.”

It was discovered in the early 2000s that ketamine very quickly kicked a major dent into symptoms of depression. And the effect lasted several days. Administration and side effect issues formed a major practicality barrier. Still, the fuse had been lit and research continues to this very day.

Incidentally, the FDA has awarded breakthrough therapy designation for the development of intranasal ketamine for the treatment of depression.

Ketamine Biochemistry

Ketamine is a glutamate NMDA receptor antagonist (blocks/inhibits action). It’s important to note that glutamate is especially prominent in the brain where it’s our most abundant neurotransmitter. Glutamate is known as an excitatory neurotransmitter, which means it enhances action potential in a neural synapse.

But remember, ketamine is a NMDA receptor antagonist, so we’re talking about pulling in the reins on glutamate influence. And that generates complicated biochemical goings-on we really don’t need to get into.

What really matters here is ketamine impacts the neurotransmitter glutamate. Antidepressants to date have targeted three monoamine neurotransmitters: serotonin, norepinephrine, and dopamine. And in so many cases, bottom-line efficacy hasn’t been anything to write home about.

So now we’re playing on a different field, aren’t we? In my book, that equates to hope.

Ketamine for Depression

News flash! Ketamine is available right now. Sure, why not? It isn’t illegal, just needs to be administered by a physician. And by far the most common administration method is intravenous infusion.

Certainly, you can chat ketamine therapy with your psychiatrist or primary care doc; however, the odds are 99:1 they aren’t going to hook you up.

So now what?

Well, you need to do your due diligence. Hop on your preferred search engine and enter something like “ketamine infusion for depression.” Bam! You’ll find tons of resources ranging from information hubs to providers.

Tell ya’ what. Since I really want you to do your due diligence, I’m going to whet your appetite with 10 “infusion-confusion” busters (no charge). And you can take it from there. Okay?

Ketamine is being used for treatment-resistant presentations of unipolar and bipolar depression – even PTSD. Its use is off-label.

By far the most common and studied administration method for ketamine depression therapy is intravenous infusion. Intranasal spray is second in line.

To be considered for infusion therapy, you’ll need a referral from a licensed mental health professional – and an initial evaluation. The cost of an infusion can run between $350 and $800. Just depends on the provider. You’ll be paying cash or using plastic because your health insurance provider more than likely won’t cover it, as ketamine isn’t FDA-approved as a depression treatment. And don’t forget the initial evaluation and follow-up consultation fees.

A typical infusion session lasts about an hour. In most cases it takes an infusion or two to determine if ketamine is going to provide relief. If it’s a go, it’s not uncommon to have six treatments, total, over the first two weeks. Then there’s the maintenance phase, during which you’ll return should you need a single infusion booster. The average duration of relief between booster infusions is three to four weeks.

When the infusion begins, you’ll feel the effects quickly. Though you won’t lose consciousness or environmental awareness, you won’t be able to stand. You’ll feel physically relaxed, but your mind will be fully engaged. Many describe the sensations as pleasant, some describe them as strange. I mean, you’ll likely experience some degree of dissociation, or a state of inner reflection. Hitting the “K-hole?” Dosing won’t allow that to happen.

Infusion results vary. Some experience relief within hours. For others, it arrives in several days – or after the second or third infusion. Relief is described as total by some. Others describe it as partial. But keep in mind, partial relief may be life-changing, given one’s misery history. Be careful with these numbers; however, I’ve read that two out of three patients will experience significant improvement and three out of four will cease experiencing suicidal ideation. But, yes, there are those for whom ketamine will do nothing.

Infusions are offered by physicians from assorted medical specialties. It seems anesthesiology leads the pack with psychiatry coming in second. The choice is yours; however, you want to make sure you’re working with someone who really understands depression and mood disorders – their symptoms and meds.

If you weren’t working with a therapist prior to receiving infusions, do so after. Relief (or disappointment) requires processing and management. A good therapist can really help.

Ketamine infusion therapy isn’t a lifelong proposition. And that’s because ketamine and ketamine-related drugs are in development. These include oral, sublingual, intramuscular, intranasal, and subcutaneous administrations. I mean, you have to believe Big Pharma is all over this profit opportunity.

Whether it’s ketamine or ketamine-related drugs in development (esketamine, rapastinel/GLYX-13, NRX-1074, CERC-301, AV-101, HNK), we’re dealing with young science. Ketamine isn’t “all-that” just yet, though relief continues to be realized. Please understand more research is required.

That’ll Do It

So ketamine for depression. Who would have thought, right? But it’s here, it appears to be real, and the future looks bright.

Sure hope our “infusion-confusion” busting has been helpful in dialing-you-in.

By the way, if you have a ketamine depression therapy experience you’d like to share, please do so in a comment. Your contribution will be extremely valuable to others.